A Perspective On The Dramatic Increase In Pharmaceutical Management Of Chronic Illness In Primary Care: Underlying Influences And Unintended Outcomes
With 45 percent of the U.S. population having been diagnosed with a chronic condition and 40 percent of people older than 60 taking five or more medications, researchers raise questions about the nature of the relationship between the expanding definition of chronic illness and the explosion in pharmaceutical use in the United States.
Using a convenience sample of 58 primary care clinicians in Michigan and 70 of their patients being treated for diabetes, hypertension or both, the authors examine some factors contributing to the dramatic rise is chronic illness diagnoses and associated polypharmacy. They suggest these trends result from a number of influences, most notably:
- increasingly lower diagnostic and treatment thresholds for common chronic conditions,
- clinician auditing and reward systems, and
- a prescribing cascade, whereby more medications are prescribed to control the effects of already-prescribed medications.
The authors identified several challenges to patient well-being resulting from the heavy reliance on pharmaceuticals, notably financial costs and adverse drug effects. They present a conceptual model, the inverse benefit law, to provide insight into the impact of pharmaceutical marketing efforts on the observed trends. To reverse these trends and limit the influence of the pharmaceutical industry on clinical practice, the authors call for:
- policies that will exclude individuals or organizations with financial conflicts of interest from involvement with clinical guideline-writing panels,
- physicians to be discouraged from seeing drug representatives, and
- the monitoring of clinician auditing and reward plans for evidence of unintended negative effects on patients.
“The Changing Face of Chronic Illness Management in Primary Care: A Qualitative Study of Underlying Influences and Unintended Outcomes”
By Linda M. Hunt, PhD, et al
Michigan State University
September/October 2012 Annals of Family Medicine